What Questions Should You Ask About Endometrial Cancer Detection?

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Gynecological cancer expert Dr. Nita Karnik Lee explains the importance of self-advocacy in endometrial cancer detection, including speaking up when you have concerns and seeking care early. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

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Transcript:

Katherine Banwell: 

What questions should patients be asking their doctor about detection? 

Dr. Nita Karnik Lee:  

For uterine cancer or endometrial cancer, detection is really based on symptoms. If there are any of those symptoms that are happening, they really should be asking, hey, I need to see a gynecologist. I need to do a biopsy. We do, unfortunately, see many patients who are sort of told, oh, it must be fibroids. But that shouldn’t happen in post-menopausal patients. I’ve heard everything. I’ve heard patients sort of self-reflect, and say, you know what, I was stressed that day, or I moved the couch that day. I’ve heard all the different things we think about, because none of us wants to feel like there could be something wrong. We often justify. It was probably nothing.  

But the patients who do the best are the patients who have a spotting episode, they have a bleeding episode, they seek care right away. And then 80 percent of uterine cancers need only surgery, so that’s a good statistic compared to some of the other GYN cancers. I would say advocating for your symptoms, not being afraid of a symptom being worked up, because I think there’s a lot of fear with, if you report something, maybe it will be something.  

And getting over that sensation of it may not be. It may be something completely different that’s benign. But I think the earlier that we can see a diagnosis and get people to treatment and/or hysterectomy, that tends to do the best in terms of survival and just getting over this episode. 

How Does Biomarker Testing Impact Endometrial Cancer Screening and Detection?

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How does biomarker testing impact endometrial cancer screening? Gynecologic expert Dr. Nita Karnik Lee reviews genetic mutations related to endometrial cancer and outlines key considerations for women with a family history of the disease. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

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Advances in Endometrial Cancer Detection

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Transcript:

Katherine Banwell:  

What is the role of genetic and biomarker testing as screening tools?  

Dr. Nita Karnik Lee:  

Those two things are different in certain ways, and it’s actually really important to think about that as well because for genetic testing if you do have a strong family history, there may be times where you are going to see a cancer genetics person. They may say, hey, your mom had uterine cancer. Maybe they are diagnosed with a certain syndrome. Lynch syndrome is the most common one, which is caused by a mutation in some of the repair proteins that normally repair DNA. That’s something that can get diagnosed and predispose people to many cancers, the most common of which is colon or uterine cancer.  

So, in those patients, some of those patients will actually undergo endometrial biopsies starting at a young age, even if they don’t have any irregular bleeding. Biomarkers are something also really important for somebody who is diagnosed already with endometrial cancer. So, if you get diagnosed with endometrial cancer, we actually use the biomarkers, which are an example of proteins the tumor has on its cell surface that can be turned on and off. And that profile of which biomarkers are on and off gives us an idea, and now can really help guide a little bit of treatment for some patients. 

Katherine Banwell:  

Okay. Should women with a family history of endometrial cancer take extra precautions? 

Dr. Nita Karnik Lee:  

I think they need to be really aware about the symptoms, and they need to be really thinking about whether or not there’s any role for genetic testing. Some patients, they have a family history. They’ve done genetic testing. It’s negative. There’s not anything else that we would do. But in those patients, if there’s any vaginal bleeding, spotting, anything irregular, that might really jump on the symptom diagnosis, or the symptoms leading to diagnosis, or sometimes people have other issues. 

They have fibroids. They have other things going on, and maybe they need a surgery, and maybe having that family history in your background sways you a little bit more. Hey, maybe I will consider surgery. It’s probably not the only reason to do a hysterectomy, but it can contribute to the decision-making if that makes sense. 

Advances in Endometrial Cancer Detection

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How are patients currently screened for endometrial cancer? Gynecological cancer expert Dr. Nita Karnik Lee discusses tools for detection and diagnosis of endometrial cancer and factors that may impact risk. 

Dr. Nita Karnik Lee is a Gynecologic Oncologist at The University of Chicago Medicine. Learn more about Dr. Lee.

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Current Endometrial Cancer Treatment Approaches

Transcript:

Katherine Banwell:  

Dr. Lee, what are the screening tests for endometrial cancer? 

Dr. Nita Karnik Lee:  

That’s also a situation that we don’t actually have screening tests for uterine cancer. Again, PAP smears are usually normal in patients who have endometrial cancer because the PAP smear collects just the cells from the outside. Occasionally, sometimes cells that are in the endometrial lining can fall down into the cervix and get found on a PAP smear. 

But that’s actually, usually, the exception and not the norm. So, most women I operate on who have endometrial cancer will have had normal PAP smears. But it’s really important to know what symptoms would really trigger the first diagnosis. So, any type of vaginal bleeding after menopause, vaginal spotting, brownish discharge, or anything that seems unusual, really warrants a biopsy. That is not exactly a screening test because screening tests are usually for patients who don’t have any symptoms, but it is really a very important diagnostic test for someone who has any of those symptoms.  

Katherine Banwell:  

Have there been advances in screening or screening technology that patients should know about? 

Dr. Nita Karnik Lee:  

Yeah, people are talking about that. We know that there are certain risk factors for uterine cancer, so there has always been a discussion about, what about maybe we don’t screen everyone. Maybe we don’t biopsy everyone, but maybe we should be biopsying some people. So, the issue of patients who have obesity is one of the risk factors, not all of them, because some patients who have obesity don’t have this, and vice versa. 

Some patients are very thin and get endometrial cancer, because there are so many different types of endometrial cancer. But I think people have talked about the idea of people who have had a real cycle of irregular periods before menopause, and then may have some risk factors such as obesity, or metabolic syndrome, or diabetes, maybe they should get screened, but that has not been advocated at a public health level. Now, patients who do have a genetic mutation should get screening tests by the endometrial biopsy.  

Katherine Banwell:  

So, you mentioned some things to look for. How is endometrial cancer diagnosed? 

Dr. Nita Karnik Lee:  

It’s diagnosed when somebody usually comes in. Most of the people will be diagnosed because they have a symptom such as vaginal bleeding or vaginal discharge. Then they will have either an office-based biopsy, which is called an endometrial pipelle or endometrial biopsy. 

Or they can have something that people have heard of before, called a D&C. That stands for dilation and curettage. That means opening up or dilating the cervix just a little bit to allow an instrument to come in and do a small scraping of the lining of the uterus. So, one of those two ways is going to be the way this is diagnosed. 

Endometrial Cancer | What Is Personalized Medicine?

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What are the common treatment approaches for endometrial cancer? Dr. Hinchcliff explains that options typically include surgery, radiation, and chemotherapy, or a combination.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

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Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Transcript: 

Katherine Banwell:  

How would you define personalized medicine?  

Dr. Emily Hinchcliff:  

So, personalized medicine I think is a big umbrella term that is sort of a buzzword in cancer right now – in a good way – but I think that it is important to understand how it affects each different cancer type. So, personalized medicine, what we mean as physicians when we say that is we are trying to better tailor treatments to the individual patient and the individual cancer.  

So, whether that is the cancer subtype, treating endometrial cancer with endometrial-cancer-specific drugs rather than drugs that have been used to treat ovarian cancer, and kidney cancer, and prostate cancer, so, using drugs that are potentially really good for your tumor type, but also using medicines that might best treat your individual tumor based on the genetics and the molecular features inside your tumor. 

One of the ways that I’ll explain it to patients is that your tumor is sort of like base camp, and it depends on certain supply chains for oxygen and nutrients to grow, and some supply chains are common to all cancer types, so if we block that supply chain, that drug might work on any different kind of cancer. But some supply chains are really specific to a particular patient and a particular tumor, and so, if we have a drug that blocks that supply chain, it might work in that particular patient, but might not work in a patient that has a very, very similar cancer type, and that’s really where personalized medicine can be a huge win. It allows us to say, “This drug would work really well for you when it might not work really well for the patient next door.”  

Katherine Banwell:  

Yeah. So, I think what used to happen is everyone with a specific cancer was painted with a broad brush. 

Dr. Emily Hinchcliff:  

Correct. 

Katherine Banwell:  

And now, we’re able to hone in on what might work for one person.  

Dr. Emily Hinchcliff:  

Yeah. I think that certainly, those broad brushes, they worked for a reason, and they still are in our arsenal and our toolbox, and so, it doesn’t mean those brushes are bad, but it does mean that now, hopefully, we can paint a little bit more within the lines. We can be a little bit more nuanced with our approach. 

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

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What are endometrial cancer biomarkers? Dr. Hinchcliff discusses how prognostic biomarkers, namely mismatch repair status and HER2, influence treatment, leading to more tailored strategies for patients.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

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Endometrial Cancer | What Is Personalized Medicine?

Transcript: 

Katherine Banwell: 

Are there prognostic biomarkers that help determine how the cancer may behave? 

Dr. Emily Hinchcliff:  

Yeah. So, endometrial cancer, we now know that the molecular mechanism – so, what I’ve been talking about, these things that are happening inside the cancer cell – we now know that that can drive prognosis, and so, it used to be that we kind of had two big buckets of cancer. 

We used to say there’s Type 1 endometrial cancer and Type 2 endometrial cancer, and now, we’ve actually broken it down into molecular categories – so, into categories much more based on certainly what the cell looks like under the microscope, but also what’s going on inside the cell, not only to impact treatment, but also to give a patient a better look at what their prognosis is expected to potentially be, and we actually have changed our staging system pretty recently to incorporate some of those molecular characteristics that we now know to check for.  

Katherine Banwell:  

Talking about the biomarkers, how do biomarkers impact endometrial cancer treatment options? 

Dr. Emily Hinchcliff:  

Yeah, so I think specifically the two that I mentioned, the mismatch repair status and the HER2 status, have really robust data that tells us that we can better tailor our treatment strategy based on a patient’s status. So, for mismatch repair, for example, if someone is mismatch repair deficient, that tumor is going to respond very well, incredibly well, to immunotherapy. So, we now actually use immunotherapy in combination with chemotherapy to treat those cancers, especially for the cancers that have spread outside the uterus or the cancers that have gone through initial treatment and then come back. 

So, I think that is a really great option. Similarly, that HER2 receptor, there is a medicine that targets that receptor, which is that cell surface molecule, that thing that’s sitting on the cancer surface, and can treat that cancer better if that marker is expressed. 

What Questions Should Patients Ask About Endometrial Cancer Testing?

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What questions should patients ask about endometrial cancer testing? Dr. Hinchcliff highlights key questions, while stressing the importance of understanding both germline and somatic tests and their impact on treatment. She emphasizes the value of open, ongoing communication with doctors.  

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

See More from INSIST! Endometrial Cancer

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Transcript: 

Katherine Banwell:  

Right. And so, what questions should patients ask about their test results? 

Dr. Emily Hinchcliff:  

Yeah, so, I think first and foremost, just getting an understanding of what tests your doctor is sending is really important. This should be an open conversation, and it’s a conversation that you should actually have as you are going throughout your cancer journey. It’s not just a conversation at your diagnosis, it’s something that, if your cancer comes back, it should be reassessed. Are there additional markers that we should send that we didn’t send in the upfront setting? Do we have a complete picture of my cancer? 

And so, I think that is definitely a question to ask, is what tests are you sending, and what is the outcome of those tests, right? How would that test change your potential management or change the options that you have for me in terms of my cancer treatment? The other thing that I will say that I think can be confusing for patients as we think about the genomics and genetics of a cancer is that it’s really important to understand the difference between something called germline and something called somatic testing, and so, I’m going to explain that, because I think it can be confusing. 

The first, germline, is a test that is testing the genetics of the whole body – so, of a person – to see if there’s anything that’s hereditary that might have predisposed them to getting cancer. And so, that is something that, if it is abnormal, it may mean that family members need to get tested, and there are things that we can do to try and prevent cancers for other people in your family that might be at risk. So, that is germline testing. 

That’s different than somatic testing. Somatic testing is when we test the tumor itself to understand what about this tumor allowed it to become abnormal, allowed it to grow abnormally and keep growing the way cancer does? And both of those are really important. So, I think as you ask your doctor, “What tests are you sending?”, it’s important to ask about tests in both of those categories. 

Essential Endometrial Cancer Testing

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What testing should endometrial cancer patients undergo after diagnosis? Dr. Hinchcliff explains the importance of determining cancer stage, histology, and performing biomarker testing, as these factors can guide more targeted treatments.

Dr. Emily Hinchcliff is a Gynecologic Oncologist at Northwestern Medicine. Learn more about Dr. Hinchcliff.

Download Resource Guide

See More from INSIST! Endometrial Cancer

Related Resources:

What Questions Should Patients Ask About Endometrial Cancer Testing?What Questions Should Patients Ask About Endometrial Cancer Testing? Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

Endometrial Cancer Biomarkers | Impact on Prognosis and Treatment

 Endometrial Cancer | What Is Personalized Medicine?

Endometrial Cancer | What Is Personalized Medicine?

Transcript: 

Katherine Banwell:   

Dr. Hinchcliff, what testing should people with endometrial cancer undergo after diagnosis? 

Dr. Emily Hinchcliff:  

So, when I think about a cancer diagnosis, there are first two big buckets of things that are important to understand. One is the cancer stage, meaning where did the cancer start, and then, where has it potentially spread to. The other is the cancer histology, or what do the cells look like under the microscope. And in endometrial cancer, there are actually a variety of different subtypes of endometrial cancer that can be differentiated based on what they look like under the microscope. Once you have those as your framework, I think the next step is to better understand what’s called biomarker testing, or the genetics of your cancer. 

Katherine Banwell:  

Would you define biomarker testing? What does that mean? 

Dr. Emily Hinchcliff:  

Yeah. So, biomarker testing – while, under the microscope, we can determine what kind of cancer something is, we can’t tell what’s going on inside the cancer cells itself, and so, biomarker testing is an umbrella term for a variety of different tests that really try and assess what’s going on inside the cancer, what are the genetics making the cancer cells divide and grow abnormally, and also, what are the things that might be expressed or on the cancer cell surface that are potentially targets for us to leverage to treat the cancer better. So, what is unique to that cancer, either the patient’s own cancer individually or that cancer type in general, that we can use to our benefit to treat the cancer better.  

Katherine Banwell:  

What are the most common biomarkers associated with gynecologic cancers?  

Dr. Emily Hinchcliff:  

So, in endometrial cancer specifically, I think if there are a couple take-homes that I can emphasize to patients in this talk today, the first is it is essential to know your what’s called mismatch repair status. So, mismatch repair is one of the things that can happen inside a cancer cell, and when that goes awry, when that becomes abnormal, it means that the cancer has particular features that we can use to treat it better. 

And so, the two categories of mismatch repair are you can be mismatch repair deficient, meaning there’s something abnormal in that machinery inside the cancer cell, or mismatch repair proficient, meaning that that machinery is still intact, and the reason for that being so important is that in endometrial cancer, if someone’s cancer is mismatch repair deficient, we can use a whole class of drugs called immunotherapy, or leveraging your own immune system using medicines to try and treat that cancer better. 

So, I think knowing that about your cancer type is really essential in endometrial cancer. I think the other thing that is important to know is in endometrial cancer, some subsets will express a receptor – so basically, something on the cancer surface – called HER2, and if you are HER2-positive, that also can be a target for potential drugs. So, those are two really important biomarkers in endometrial cancer that I think it’s important that patients know that they have been tested, and then know what their results are.